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Do You Ever Self-Diagnose Foot Problems Using Google?

We all love the internet. There is a lot of information we can easily glean from it. But take care not to over-diagnose or misdiagnose yourself when it comes to several issues of the foot and ankle. In this article we will explore some of the most common foot conditions that are often misdiagnosed by the internet, your friends and even “Dr Google.”

TOENAIL FUNGUS

Maybe you have a nail that is yellowed, thick, dark, difficult to cut, white, brown or even loosening. We’ve all seen “digger the dermatophyte” or the “toe that plays tennis” on TV. You may quickly think that if your toenail looks like the one on TV, then you must have fungus on your nail or in your nail and then seek out some over-the-counter product or ask your doctor to put you on “that pill for fungus.” But the reality is that this icky looking nail could be caused by a host of different things; and if you are treating your nail for fungus which you do not have, then surely your treatment will fail.

prevent ingrown toenailsEven the most experienced foot specialist (podiatrists) and dermatologists can’t look at your nail and make the correct diagnosis with 100% accuracy. That is why a nail biopsy should be done to determine the exact cause of the problem before treatment options are discussed. A nail biopsy is a simple procedure that takes about 30 seconds to perform and allows for microscopic exam of the nail area to determine if in fact there is fungus present…and if not, what else it is that is causing your nail to look this way.

Multiple skin conditions can affect the nails: psoriasis, lichen planus, etc. Nails can also become unsightly as a result of trauma such as dropping a heavy object on your toe years ago, or poor shoe fit causing repetitive micro-trauma to nails that get too long.

Other problems can cause nails to get discolored or disfigured as well. So be careful before deciding on a treatment for your “fungus nails” and keep in mind that only 40% of the nail biopsies done in our office come back as fungus being the cause that needs treated. The other 60% come back as something other than fungus and the treatment options are clearly different.

WARTS

It is true that we can get warts on the bottom of our feet. And they can, sometimes be painful. And they sometimes look like a white bump or have black dots in them. But there are several other lesions that can present in a somewhat similar fashion, especially to the untrained eye.

It is certainly not a hard and fast rule, but generally warts occur in children. Once you have had a wart however, caused by a virus, you will keep that virus in your system for life and you have a 20% chance of a wart showing up again (on your feet) at any time well into adult years.

Another skin lesion commonly misdiagnosed as a wart is called a plantar porokeratoma (or PPK). This is not caused by a virus and the treatments therefore are very different. Again, not a hard and fast rule, but generally speaking a PPK is going to be seen most often in women over the age of 40 and frequently on the ball of the foot behind the 2nd toe. These are a result of a clogged sweat gland, tend to be very tiny (1-2mm in diameter) but painful, and white or yellowish in color.

Most importantly if you have a skin lesion on your feet that is “new” or if you have a sudden change in size or color or shape of a skin lesion that had been stable and unchanged for a long time, you should see your podiatrist for a possible biopsy of this lesion. Skin cancers are not common on the feet, but they do occur and only biopsy can ensure proper diagnosis and treatment for a suspicious lesion.

HEEL PAIN

Do you step out of bed and feel a sharp nail driven into your heel? Do you feel less pain as you walk around for 15-20 minutes, but the pain occurs again when you stand up after periods of rest during the day? If so, Dr Google suggests you have plantar fasciitis. This is an inflamed band of tissue on the bottom of your foot that attaches near your heel bone. So you start some stretching, icing, maybe change your shoes…but pain persists. The truth is that heel pain can be caused by over 10 different things. Only one of which is plantar fasciitis. If your treatment is not targeted toward the proper diagnosis then more of the same treatment will not get you better.

Common, proper initial treatments for plantar fasciitis may include stretches, orthotics, injection, oral medications, education on shoe selection, etc. But if you have a tear in your plantar fascia or if the plantar fascia is degenerated rather than inflamed, then these treatments will not be successful. So if your “self treatments” aren’t showing positive results or if you are receiving professional treatment and not improving, then further investigation is warranted. This may be done by way of diagnostic ultra-sound or MRI. Bloodwork is occasionally indicated to diagnose different types of arthritis’s which may also cause heel pain. Bottom line: pain in the heel is not always “plantar fasciitis.”

PEDICURES

Yes or no? The answer is: that depends. Typically pedicures are not going to be the cause of nail fungus or ingrown nails or where one might pick up infections such as warts or fungus. But be certain that your pedicurist as well as the salon are licensed and accredited by the State Medical Board. It’s also a good rule of thumb to expect to pay a minimum of 30$ for a pedicure and you should stick with a reputable facility.

It is not recommended by most podiatrists that “cuticle work” be done. This is where the cuticle is “pushed back” and then “trimmed away” as your cuticle offers a line of defense against infection. Also keep in mind that if you have any open wounds on your feet you should not get a pedicure until the wound is closed. If you have decreased sensation in your feet such as from diabetes, age, malnutrition or other causes, don’t allow the water temperature to get too hot. It is a myth that toenail polish causes fungus; but there are certainly polishes which have anti-fungal components to them which are healthier for your nails.